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Reproduction and the growing child > Normal labour and its management > Flashcards

Normal labour and its management Flashcards

1
Q

Causes of maternal morbidity -

A
  1. exhaustion
  2. dehydration
  3. electrolyte disturbance
  4. demoralised
  5. pain, fear
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2
Q

Risks of vaginal delivery -

A

Acute and chronic trauma to pelvic structures

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3
Q

Risks of c-section -

A

Trauma to abdo organs
Future labour complications
Anaesthetic complications Haemorrhage

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4
Q

What causes the onset of labour?

A

Forces of release > forces of retention

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5
Q

Forces of retention:

A
  • Progesterone
  • Adrenaline
  • Cervix firm and fibrous
  • Hypervolemia
  • Relaxin
  • CRH
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6
Q

Why is hypervolemia a force of retention?

A

Inhibits release of oxytoxin and vasopressin from PP gland

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7
Q

Forces of release:

A 
Oestrogen
Oxytoxin
Vasopressin
Cortisol
Prostaglandins
CRH
Uterine distension
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8
Q

Hormones which increase contractions:

A

Oxytocin

Vasopressin

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9
Q

Oxytocin and vasopressin are released from:

A

Posterior pituitary gland

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10
Q

Cortisol from the foetal adrenal gland blocks the action of:

A

Progesterone

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11
Q

Function of prostaglandins:

A

Sensitise uterine muscles to oxytocin receptos

Cause cervical dilation

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12
Q

Posterior border of pelvic inlet

A

Sacral promontory

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13
Q

Anterior border of pelvic inlet

A

Pubic symphysis

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14
Q

lateral border of pelvic inlet

A

Iliopectineal line

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15
Q

Lateral border of pelvic outlet:

A

Ischial tuberosity and sacrotuberous ligament

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16
Q

Posterior border of pelvic outlet:

A

Tip of coccyx

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17
Q

Anterior border of pelvic outlet:

A

Pubic arch

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18
Q

Transverse diameter is greater where

A

Inlet

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19
Q

AP diameter is greater where

A

Outlet

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20
Q

Most common female pelvis shape =

A

Gynecoid

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21
Q

Most common male pelvis shape =

A

Android

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22
Q

Gynecoid pelvis =

A 
Wider and broader outlet
Oval-shaped inlet
Less prominent ischial spines
Greater angles sub-pubic arch
Shorter sacrum
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23
Q

Android pelvis =

A

More triangular

narrow pubic arch

24
Q

Anthropoid pelvis has a wide =

A

AP diameter

25
Q

Platypelloid pelvis has a wider =

A

Transverse diameter

26
Q

Pelvic floor is innervated by =

A

Pudendal nerve

27
Q

What can be used to make contractions more coordinated and efficient?

A

Oxytocinon drip

28
Q

Most favourable diameter of baby’s head =

A

Suboccipito-bregmatic

29
Q

Suboccipital bregmatic diameter =

A

Babies head flexed

30
Q

Type of presentation that required C-section as diameter is too large to fit through pelvis =

A

Brow-presentation

31
Q

Best diameter to present of hear (number)

A

9.5 cm - fully flexed or fully extended

32
Q

How to feel for babies position:

A

Feel sagital sututre and fontanelles

33
Q

Shape of anterior fontanelle -

A

Diamond

34
Q

Shape of posterior fontanelle

A

Triangle

35
Q

Positions of head:

A
  • OA (LOA, ROA)
  • OP (LOP, ROP)
  • OT (LOT, ROT)
36
Q

‘Cardinal movements of labour’

A
  • Engagement
  • Flexion
  • Internal rotation
  • Extension
  • External rotation
  • Expulsion
37
Q

Internal rotation =

A

Transverse to OA

38
Q

What position is head when babies head is visible?

A

OA

39
Q

External rotation =

A

OA to transverse

40
Q

Presentations:

A

Chephalic
Shoulder
Breach

41
Q

Effacement =

A

Cervix soften, become thinner

42
Q

Stages of labour (1)

A

Onset of contractions, first irregular and then more regular.
0-4 cm then 4-10 cm
Cervix become effaced

43
Q

How long does 1st stage last?

A 
NP = 9 hrs
P = 6 hrs
44
Q

2nd stage of labour:

A

From full dilation to delivery

45
Q

How long does 2nd stage last?

A 
NP =  1 hr
P = 15 mins
46
Q

3rd stage of labour:

A

From delivery of baby to delivery of placenta

47
Q

Why is active management of stage 3 important?

A

Post-partum heamorrhage

48
Q

How to reduce blood loss:

A

Syntocininon, Syntometrine (oxytocin, syntocinon/gametrin) –> contraction of uterus

49
Q

How is labour managed?

A
  • Birth plan
  • Partogram
  • Regular bladder emptying
  • Analgesia
  • Vaginal exam
  • Monitor mother and foetus
  • Episiotomy
  • Active management of 3rd stage
50
Q

Why is regular bladder emptying important?

A

May effect descent of head into pelvis

51
Q

Vaginal exams are performed every

A

4 hours

52
Q

Ex of something to observe for

A

Sepsis

53
Q

When is an episiotomy indicated?

A

Sign of perineum becoming over distended

54
Q

Analgesia used in labour:

A
  • TENS
  • Entrenox
  • Systemic opiates - pethidine, morphine
  • Epidural
55
Q

Ways to monitor fetal well being

A

Intermittent auscultation

Continuous monitoring

56
Q

Why does a babies ECG look wiggly?

A

Receptors in fetal heart are more sensitive. Constantly change is response to minor changes. If baby becomes distressed, will lose ability to make microadaptations and line will flatten

Reproduction and the growing child (15 decks)

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